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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153902778
Report Date: 11/07/2023
Date Signed: 11/07/2023 11:32:21 AM


Document Has Been Signed on 11/07/2023 11:32 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:CHAIRENZA, NANCY FAMILY CHILD CAREFACILITY NUMBER:
153902778
ADMINISTRATOR:CHAIRENZA, NANCYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 256-8155
CITY:ROSAMONDSTATE: CAZIP CODE:
93560
CAPACITY:14CENSUS: 3DATE:
11/07/2023
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Nancy Chairenza, LicenseeTIME COMPLETED:
11:30 AM
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On November 7, 2023, Licensing Program Analyst (LPA) Calloway met with Licensee, who granted access. LPA and Licensee toured the home for an Annual Random inspection. Family members residing in the home include 2 adult (licensee and spouse) and no children. The home is licensed for fourteen (14) children. LPA observed three (3) day care children in active play and one (1) staff (Licensee). Incidental Medical Services (IMS) policy was discussed and is being provided. LPA recommended a written plan be submitted to Licensing for the IMS services.

Physical Plant: This is a two story 4-bedroom, 4-bathroom home with kitchen, dining, family room, living room, formal dining room, laundry room and garage. Childcare is provided in enclosed patio sunroom (permitted) next to the family room. Children’s Bathroom #2 (boys) is in day care area observed and Child’s Bathroom #1 (girls) inside the home both free of hazards. Disinfectant spray in cabinet Bathroom #1 up high inaccessible to children. Unused outlets (covered). Age-appropriate toys, furniture, and books. Napping (mats) equipment. The home was inspected inside and out for safety, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (kitchen cabinet/laundry room up high), medicines (laundry room- up high). Kitchen hazardous items that can pose a danger to children (sharp knives in a cabinet- locked up high). Fire/earthquake drills not complete. Roster (current). Isolation area is in the living room (mat) until parent can pick up
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CHAIRENZA, NANCY FAMILY CHILD CARE
FACILITY NUMBER: 153902778
VISIT DATE: 11/07/2023
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The required fire extinguisher (2A10BC) (full/green). Smoke detectors and carbon monoxide detectors (operable). Fireplace is screened. Home has central AC and heat. Required postings were present on the wall. There is a landline phone and cell phone. No Fire pull alarm observed. LPA recommended Fire alarm, if recommended by City Fire Department. Blind cords were not up high. LPA recommended them to be tied up and inaccessible to children. Stairs (gated).
Off limit areas: Upstairs: include Bedrooms (#1, #2, #3 #4), Bathroom #3, Bathroom #4, garage, kitchen, laundry room.
Outside: The backyard is completely fenced. There is concrete and grass for play. One (1) dog (vaccinated), Per Licensee the dog interacts with the day care children. Play structure and swing set observed anchored and is wobbly in two spots. LPA recommended Licensee to tighten and fix the play structure and add cushioning material underneath to prevent injuries in case of a fall. There are age-appropriate toys for play. There is an in-ground pool/body of water on the premises. It is fenced around with a mesh fencing that is anchored in the ground, sturdy, with a self-latching gate five feet high. There were storage sheds in the grass area. LPA recommended all sheds to have a lock.
Others: Per Licensee, there is a firearm on the premises. It is kept upstairs (bedroom off limits) in a steel gun safe; ammunition is kept separate (locked, container). LPA did not observe the firearm in the off-limits bedroom. Required training & CPR/First Aid (not current). First Aid kit observed (complete). LPA viewed staff and children’s file and conducted a staff interview with the licensee. Transportation is not provided
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CHAIRENZA, NANCY FAMILY CHILD CARE
FACILITY NUMBER: 153902778
VISIT DATE: 11/07/2023
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The following was discussed with the Licensee:
Maintain capacity requirements, Notification of Parent's Rights, Roster requirements (keep updated names), Documentation requirements for disaster drills (fire and earthquake). Mandatory Forms for the children’s files and provider’s files, updated Safe Sleep regulations were provided. The role and responsibilities of being a mandated reporter were reviewed. Licensee reminded that 100% supervision is always required to children in care. If food is brought in, it is properly labeled. Licensee will check food expiration dates periodically. Licensee was advised on how to access forms and Regulations for Family Child Care online at www.ccld.ca.gov. Licensee was made aware that it is their responsibility to know the regulations as well as anyone who assists in providing care. Licensee advised that inaccessibility of hazards must be constantly reassessed depending on the children in care. Licensing must always have the facility’s phone number; if the phone number is changed, licensing must be notified. Regulation prohibits the smoking of tobacco in a private residence that is licensed as a family childcare home and in those areas of the family day care home where children are present (24/7 ban). Type A citation: Type A citation(s) shall be posted for 30 consecutive days along with the Notice of Site Visit Letter (printed out after every visit) and posted during hours of operation, as there is/are immediate risk(s) to the health, safety, or personal rights of children in care. Licensee shall provide a copy any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification. Failure to do so will result in a Civil Penalty being assessed. State law prohibits baby walkers, bouncy seats, exersaucers, and any other items that fall into that category. Licensee is advised visit www.shotsforschool.org for Immunization information.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
Page: 4 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
PALMDALE CHILD CARE, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: CHAIRENZA, NANCY FAMILY CHILD CARE
FACILITY NUMBER: 153902778
VISIT DATE: 11/07/2023
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--Licensee was informed of responsibility to report suspected Child Abuse, 1-800-827-8724/760-243-6640
--Family Child Care Providers (Disaster Planning information):https://cccld.childcarevideos.org/family-child-care-providers/disaster-planning-and-fire-safety/--Child Care Advocates information: www.childcareadvocatesprogram@cdss.ca.gov
--Child Care Videos: https://ccld.childcarevideos.org -Licensee advised to visit the CCL website (www.ccld.ca.gov) to obtain updates of courses and updates/changes to the regulations.
Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm

The On Duty Worker is available for questions at (661) 202-3318 Monday-Friday 8am-5pm for information and reporting Unusual Incident reports: @ unusualincidentreport@dss.ca.gov. using LIC 624B form. LPA discussed (Safe Sleep) during the inspection. There are no infants in care at this time.

Per Title 22 Regulations, there are deficiencies cited during the inspection.

An exit interview was conducted, a copy of this report was read, and a Notice of Site Visit, Appeal Rights, were provided to Nancy Chairenza, Licensee. A Notice of Site Visit must remain posted for thirty (30) consecutive days. Failure to maintain the posting will result in $100 civil penalty.

SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 202-3407
LICENSING EVALUATOR NAME: Kuliema CallowayTELEPHONE: (661) 202-3381
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4